While yes, some physicians are charging outlandish rates, Medicare
reimbursement rates can hardly be used as a measuring stick for a
good value. While it definitely is not worth $44k, does anyone
believe that cholecystectomy is really only worth $849?
GIven the skewed reimbursement model, physicians, patients and
payers alike have no concept of how to define a health care value
and reimburse accordingly. So we have this broken system that will
never ever be fixed as long as there are multiple 3rd party payers
who engage in price fixing, with Medicare being the biggest price
fixer of all. As long as no one knows who's paying what, health
care value is impossible to determine..

DoctorSH

02/07/13

Agree with Keely.
I am surprised, well maybe not, that medpage would print such an obviously biased article written purely from the
standpoint of the insurance industry.
Why not look at how many procedures insurance rejected for payment. That percentage decrease is Infinite!.

ChasinRabbits

02/07/13

It doesn't matter if
a physician charges
$1 million dollars
and the procedure is
only reimbursed $1.
That physician can't
collect the
non-covered charges
because that is
called "balance
billing" and that is
illegal..

Jason Boardman

02/07/13

I agree. what a physician charges is not what a physician gets paid. Also Medicare reimbursement was never meant to be the "gold standard" of reimbursement when it was created. Medicare was created as a supplemental insurance and not as a stand alone.
FInally this points the fingers at physicians, but fails to look at hospitals who charge (even in network) 10s of times the costs..

ChasinRabbits

02/07/13

Here's another
thought as to why
out-of-network or
in-network
physicians charge
higher than the
reimbursement rate:
the lack of a price
list issued by the
insurance company or
by Medicare. If you
charge $10 for a
procedure MEdicare
or the insurance
companies reimburse
at $15, you will be
reimbursed $10 only.
If you charge $25
for a procedure
Medicare or
Insurance companies
reimburse $15, you
will be reimbursed
only $15. So if you
don't have a price
list, it's better to
charge a
ridiculously high
amount to ensure you
get the full
reimbursement. These
are the games
beneficiary and
insurance companies
play on physicians..

Ms. King RN

02/07/13

Agree with all of the post so far, the system is broke & needs to be fixed before
you can compare. It made me laugh at what Medicare reimburses. My dog's
ligaments replacements cost more then twice what Medicare reimburses, & felt
his surgeries were more then fair. Also done in Des Moines so not where the cost
of living is high..

karol wolicki

02/07/13

Medicare is illegal taking, plain and simple. It is so arduous to
exclude oneself from Medicare that most physicians are simply
coerced into accepting Medicare and its generally fraudulent and
lousy reimbursements. The government calls this voluntary
compliance, but its like someone volunteering for the military when
their draft number was 3.
I agree that this article is sorely biased on behalf of lower
prices, with no regard for physicians' labors. Back to the
founding fathers' advice: "We must hang together or we shall
surely hang separately!".

Barbara Daiker, RN, PhD

02/07/13

Charges are used by
providers to
establish a rate
that keeps their
reimbursement at the
amount allowed by
all payers. They
have one charge for
a service, but
reimbursement varies
among payers.
Medicare is one of
the lowest payers.
It is ridiculous to
analyze charges to
allowed amounts..

Stratocaster

02/08/13

The notion that "the
AHIP survey did not
factor in the cost
of providing these
out-of-network
services --
including such
things as office
overhead and
malpractice
insurance -- and
only considered what
the physician
charged" is
self-serving and
disingenuous.
Providers don't take
the out-of-network
charged amount and
put it in their
wallet. They have
to pay "such things
as office overhead
and malpractice
insurance" from
their practice
incomes unless they
are employed by, for
instance, a
vertically
integrated health
delivery system.
(But if they were,
they wouldn't be
billing outrageous
out-of-network
fees.) Any provider
who doesn't realize
that will soon go
bankrupt. If you
can't do the math,
you aren't putting
your greedy hands on
me, buster..

ChasinRabbits

02/08/13

@Daiker, "Medicare
is one of the lowest
payers" where in the
country do you live?
In most places,
private health
insurance companies
use the Medicare
rate as a "ceiling"
amount for their
reimbursements. So
if Medicare will
reimburse $15 for a
flu shot, the
private insurers
will reimburse $15
or lower..